PL-06-1760Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 02/16/2007
Inspector: Levrack, James
Owner: BURNSIDE, JEFFREY
Job Address: 290 98 Street NE
Miami Shores Village, FL 33138-
Project: <NONE>
Contractor: SUBURBAN PROPANE
Block:
Permit Type: Plumbing - Residential
Inspection Type: Final
Work Classification: Gas
Phone Number (305)757 -4955
Parcel Number 1132060134150
Lot:
Phone: 305 - 891 -8393
Building Department Comments
INSTALL (1) 200 H LP TANK GAS
19. F B4 cf-21# 7
ii
970
Passed
=
or Comments
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Thursday, February 15, 2007
Page 1 of 1
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING iUN 2 2006 AO Permit No. - 1 160
PERMIT APPLICATION), f s Master Permit No.
FBC 2001
Permit Type (circle): Building
Mechanical Roofing
Owner's Name (Fee Simple Titleholder) 6-/./9- / 4J2 ,13f'/L, /Sit Phone # 6-30‘,/ # 9 1e
Owner's Address FL) A / 7 3f
City iii /4/n' /104.42 State
Tenant/Lessee Name
Zip -.5 3 /3
Phone #
Job Address (where the work is being done) / N 5f S
City Miami Shores Villa • e County Miami -Dade Zip e, (3 Y
Is Building Historically Designated YES NO
Contractor's Company Name S'U"Ltv 60 / , 2 /"O fi rilZ
Contractor's Address //5 / A/6 13 c 140 "-
city //'/ State Pc--
Qualifier i1 i i et(ir"
Phone # 647'7
?�3
Zip 33 /G
State Certificate or Registration No. L P6 % Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this Permit
Cep
Square Footage Of Work:.
Type of Work: ['Addition ['Alteration ❑New ❑ Repair/Replace ❑ Demolition
Describe Work: / A/ S'it'e.'_ / -- /4
Submittal Fee $ Permit Fee $ � CCF $ 0 •G' - CO /CC.
Technology Fee $ 1.
Notary $ Training/Education Fee $ CD - Z.-CD .
Scanning $ 5 , W ' Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite side)
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Zip
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that-all work will be performed to meet the standards of all laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOL'S, FURNACES', BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S ANFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT."
Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection ;Which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the
inspection will not be approved a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before me this 72
20° by
own to me or who has produced
Signature .9
Contractor
The foregoing ' strument was aclupwledged before a this t
AV!
day of
w
NOTAR
Sign:
Print:
My Commission Expires:
1 ' s 'V4:. RGEUO QUEVEDO
+. MY COMMISSION # DD 447106
Q EXPIRES: July 4, 2009
�4 a ThrU Notary Publ°U m
°Troced
wad who dpi take an oath.
NOTARY PUBLIC:
****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY:
chc 05/13/03
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * **
e‘ Plans Examiner
Engineer
Zoning
• ••
.. •
• ••
•
• ..
.. •
••••
• ••
•••• •
• ••••
LX� eitc fA)X le
40/D,ce' o ( - 791,e9c #4 ,o
N. 1Zn S'10 2
,/1.-
-01Dibr'
Dome
IMOMEWEI
�l Jug 2 8 2006 aJ
tpL p p 1-14"1*
15 4. 6 444
•••
..
••••
•
•
sea spy
grow'
Suburban Propane
1491 N. f. 1309 i Street
N. Miami, FL 33161
305 -8g1 -8333
Qualifier
Job Address
Longest Run
Total BT'IJ's
NE
1474/